Histopathological Evidence of Occipital Involvement in Male Androgenetic Alopecia

Khunkhet, Saranya; Chanprapaph, Kumutnart; Rutnin, Suthinee; Suchonwanit, Poonkiat

doi:10.3389/fmed.2021.790597

Cited by 12 publications

(21 citation statements)

References 36 publications

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“…Molecular studies have identified the organism in the affected follicles, supporting the theory of specific immunological reactions to treponemal antigens ( 26 – 28 ). Histopathological evidence revealed perivascular and perifollicular lymphocytic dermal infiltrates, and immunohistochemistry confirmed spirochetes to be present in the peribulbar region and penetrate the follicle matrix of SA ( 26 – 28 , 35 ). These pathologic findings could explain the trichoscopic features of the hair shaft abnormalities resembling alopecia areata (i.e., zigzag hairs) and trichotillomania (i.e., broken hairs and black dots).…”

Section: Discussionmentioning

confidence: 91%

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

et al. 2022

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BackgroundSyphilitic alopecia (SA), which mimics other types of alopecia, is an uncommon manifestation of secondary syphilis. Trichoscopic features may facilitate its diagnosis. However, studies on SA and its trichoscopic characteristics remain limited.ObjectiveTo investigate the epidemiological, clinical, and trichoscopic findings and laboratory results, treatment, and outcomes of SA in Thai patients as well as to comprehensively summarize all trichoscopic features of SA through a systematic review.MethodsData on patients diagnosed with SA between December 2010 and December 2021 were obtained from their medical records and analyzed retrospectively. A systematic review of trichoscopic data, both from our institution and from studies registered in the PubMed, MEDLINE, and Embase databases, was conducted. A descriptive summarization was performed to comprehensively study the trichoscopic features of SA.ResultsOf the 205 patients with secondary syphilis, 23 patients with SA (symptomatic SA: 20, essential SA: 3) were included. The mean age was 27.6 ± 8.8 years, and male predominance was noted. The moth-eaten pattern was the most common SA presentation, and the parieto-occipital scalp was the most commonly affected area. All patients with SA achieved significant hair regrowth within 3 months of antibiotic therapy. Trichoscopic images were available for 20 patients with SA from our institute and were included in the systematic review. Fourteen articles provided information on 21 patients. Overall (N = 41), 26 (63.4%), 8 (19.5%), and 7 (17.1%) patients had moth-eaten alopecia, diffuse alopecia, and mixed alopecia, respectively. The most frequent trichoscopic finding was short regrowing hairs (78%), followed by decreased hair per follicular unit (75.6%), and empty follicles (51.2%). Unique features included flame hairs, bent tapering hairs, reddish-brown background, and brown rings around the perifollicular areas, each described in one case. However, the results were based only on case reports and small case series.ConclusionsGiven the progressively increasing frequency of SA, trichoscopic examination may be valuable when SA is suspected in patients with idiopathic alopecia; however, our findings are quite non-specific. The absence of exclamation mark hairs may help in the diagnosis of SA. Further comparative studies on other types of alopecia are required to determine the most useful diagnostic features.

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Section: Discussionmentioning

confidence: 91%

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

et al. 2022

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“…The results in this study might be contrast with the results and analysis of the previous studies regarding the androgenetic effect upon the occipital area, due to the lack of evidence of miniaturization. 4,7,8 But it is important to take note that, the majority of the population in this study belonged to the less disease-severity groups (Hamilton-Norwood classification type II and III) and was relatively younger than the Thai male with AGA subjects in the previous study. 4 These observations could explain the less androgenetic effect in the population included in the present study.…”

Section: Discussionmentioning

confidence: 71%

“…However, recent published data regarding the androgenetic effect on this nonbalding scalp area in AGA cases have been reported in both males and females. [3][4][5] Evaluation of hair density from the occipital scalp in individuals with AGA could reassure the appropriate quality and quantity of hair from the donor site suitable for hair transplantation surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Therefore, we aim to evaluate the average number of hair follicles and follicular density at the occipital scalp in Thai males with AGA for the reference record and to compare with the previous studies in Thailand. 4 Furthermore, we aim to compare the hair count parameters with the previous published data of hair counts in general Thai population and among other ethnics worldwide. 1, [7][8][9][10][11][12][13]…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Hair Follicle Counts of Occipital Scalp Biopsies from Male Hair Transplant Patients in Thailand

Pattanaprichakul

Thuangtong²,

Thanomkitti³

et al. 2023

Siriraj Med J

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Objective: To evaluate the average hair follicle count from the occipital scalp of Thai males with AGA who were candidates for hair transplantation. Materials & Methods: A cross-sectional study of 47 male with AGA undergoing hair transplantation surgery was conducted. The 4-mm punch biopsies from the occipital scalp were evaluated for hair count parameters. The results were compared to prior studies. Results: The average counts of total hair follicles and the density of hair follicle per square millimeter were 18.6±1.2, and 1.5±0.1, respectively. The terminal-to-vellus ratio was 11.1, and the percent ratio of anagen-to-telogen ratio was 91.9:8.1. The hair count number is significantly lower than other ethnicities including Thais in general population (P < 0.001), but greater than the Thai males with AGA in the previous study. (P < 0.001). Conclusion: Our study showed a lower average hair density as compared to the other normal Asian population. The total hair count in the occipital area from this study is less when compared to the previous studies conducted in Thai normal controls but higher than those with more advanced AGA. This result supported the evidence of hormonal effect involving the occipital scalp of male AGA.

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“…It is widely accepted that the occipital region of the scalp is an unaffected area of AGA, and in a previous study, the occiputs of AGA cases were used to determine reference data for normal scalp. 6 However, Khunkhet 17 recently found that AGA can involve the occipital area of male patients. We also found that some volunteers whose hair parameter data were excluded from analysis showed pathologic features of AGA in occipital areas, which was in accordance with Khunkhet’s finding, indicating that occipital area may be involved by AGA even in an early stage.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Trichoscopic and Histopathological Evaluations of Hair Parameters

Hu¹,

Tu²,

Yang³

2022

CCID

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Background Collecting data on hair counts helps dermatologists diagnose hair diseases more accurately. Quantitative trichoscopy analysis and pathologic examination are two common ways to evaluate hair parameters. Purpose The study aims to compare the effect of quantitative trichoscopy analysis and pathologic examination in hair counting and quantify the hair density of average Chinese people. Methods Trichoscopy was performed in four scalp regions with a total of twenty-three volunteers without alopecia: frontal, vertex, occipital, and parietal. Hair density parameters were recorded. A 4-mm punch biopsy was performed in the occipital area, and all specimens were transversely sectioned serially and observed to calculate the hair densities. Results The average hair density, hairs per follicle unit, and vellus hair ratio from quantitative trichoscopy analysis in the occipital region were 163.07±28.17/cm 2 , 1.87±0.25 and 6.60±3.95%, lower than those from biopsy significantly (214.97±48.73/cm 2 , 2.24±0.30 and 10.48±6.43%). The hair shaft diameter measured by quantitative trichoscopy analysis was 74.52±8.02μm, higher than that by histopathologic examination (68.65±8.00μm) (p<0.05). Conclusion Quantitative trichoscopy is a noninvasive, quick, and convenient way to evaluate hair density. Histopathologic examination is an invasive way but provides more accurate data. The data obtained from trichoscopy and pathological examination are different to some extent, which cannot be substituted entirely for each other. This study established the reference for hair density in the adult Chinese population.

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Histopathological Evidence of Occipital Involvement in Male Androgenetic Alopecia

Cited by 12 publications

References 36 publications

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

Evaluation of Hair Follicle Counts of Occipital Scalp Biopsies from Male Hair Transplant Patients in Thailand

Comparison Between Trichoscopic and Histopathological Evaluations of Hair Parameters

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